John Weeks July 2013 Integrator Round-up covering the topics of Integrative health care policy

Advisory Group on Prevention urges Surgeon General to issue guidance on non-discrimination, Section 2706

The Advisory Group on Prevention, Health Promotion and Integrative and Public Health, established under the Affordable Care Act, has urged Surgeon General Regina Benjamin, MD, MBA and the Department of Health and Human Services to “issue guidance to states regarding compliance with Section 2706 [‘Non-discrimination in Health Care’] of the ACA and its relationship to all plans offered through the states’ health insurance exchanges.” The 4-page letter, authored by Jeffrey Levi, MD, the chair of the National Prevention Council, followed a late March 2013 meeting of the Advisory Group which Levi convenes. In addition, the letter urged the “appropriate use of the healthcare workforce as defined in Section 5101 of the ACA.” That section, which includes chiropractors and other “licensed complementary and alternative medicine providers, integrative health practitioners,” has never been funded.

: States are in need of some affirmative guidance on 2706, as described here, and on 5101 (National Healthcare Workforce Commission). Notably, however, this push from the Advisory Group on these two sections was not the first recommendation in this 3rd year report from the Advisory Group. Rather, these were lumped and dead last, on page 4 of the letter. Still, good to see the inclusion. I am guessing advisory group member Janet Kahn, PhD had a hand in that. 



Georgetown University group’s Affordable Care Act implementation check list notes Section 2706, non-discrimination

An Affordable Care Act Implementation Checklist developed by professionals at Georgetown University references Section 2706 on page 12 of the 22 page document. The category is doubly listed as “Providers operating within their scope of practice cannot be discriminated against” and “Issuers may not discriminate against any provider operating within their scope of practice.” The Georgetown team offers this “tip”: “Check to ensure that if a service/treatment is covered that there are no limitations on licensed providers who can provide that service.”

Comment: The “tip” may be limiting, yet is the accepted, limited view of most regulators. One wonders why Senator Harkin could have advocated this section for his chiropractic and integrative health friends if, for instance, a chiropractic adjustment was not included. Some believe that the meaning of non-discrimination is that, if for instance treatment of back pain is covered, then non-discrimination would allow any licensed practitioner to bring what tools they have (for instance adjustment) to the task. Apparently, gaining such an interpretation, as Deborah Senn was able to do in Washington State when that jurisdiction passed its Every Category of Provider act, will need a lawsuit, or more than one lawsuit, as argued here.



Integrative health academic consortium injects health and well-being into Institute of Medicine workshop

A comment from TEDMED 2013 by GW Bush’s nephew that “exogeneus factors” will be necessary to leverage change in medicine led this author to reflect on the role of integrative health and medicine leaders in bringing “health and well-being” into focus in a May 2013 Institute of Medicine workshop. The focus of the IOM meeting was on an imagined, coming era of “Transdisciplinary Professionalism.”  Integrative health leader at the University of Minnesota Mary Jo Kreitzer, RN, PhD and Elizabeth Goldblatt, PhD, MPA/HA from the Academic Consortium for Complementary and Alternative Health Care (ACCAHC) carried the health and well-being content. ACCAHC, a member of the Forum while yet an “exogenous factor” relative to most mainstream healthcare dialogues, had taken the lead in introducing the health-focused content into the meeting.

Comment: I’ve been intimately involved with the ACCAHC work, through my consultancy with that organization. I am particularly proud of Goldblatt’s success in carrying an overt focus on health outcomes into that gathering of health professions educators and leaders across all fields. We need to be overtly bringing health, healing and well-being outcomes into these debates. A full column on this IOM example in fulfilling this need for exogenous input is here, at Integrative Practitioner.



Senator Harkin as pitch man for the naturopathic medical profession

A transcript of the comments of US Senator Tom Harkin to members of the naturopathic medical profession strongly suggests that he will advocate for their inclusion in diverse federal programs. He states: “No question, NDs and integrative medicine can and must play a very big role in this transformation.  We need an expanded role for NDs in order to reduce the shortage of primary care providers. Just as importantly, we need your sharp emphasis on wellness and prevention, and your (naturopathic doctor) pragmatism in taking full advantage of the very best available therapies, whether from conventional western medicine or from alternative sources and traditions.” He then directly urges inclusion of NDs “in the Commissioned Corps of the US Public Health Service, and also in federal health programs generally.”

Comment: The NDs better act fast. Harkin has announced that 2014 is his final year in office.



Obama administration issues rules on employment-based wellness – are employers hand-cuffed?

In a May 29, 2013 release from the US Department of Labor, final rules for employment based wellness programs were revealed. The rules are expected to “support workplace health promotion and prevention as a means to reduce the burden of chronic illness, improve health and limit growth of health care costs, while ensuring that individuals are protected from unfair underwriting practices that could otherwise reduce benefits based on health status. “Participatory wellness programs” such as discounted fitness center memberships are strongly endorsed. The rules also define the more challenging area of “non-discriminatory health-contingent programs” that reward those who meet specific health goals, such as body mass index. The final rules are here. They go into effect January 1, 2014.

Comment: I spoke with a colleague familiar with the issues who ventured: “I think they put more handcuffs on the employer. Employers have so much skin in the game. Individuals can just say ‘I have what I have, and you have to treat me.” My colleague thought that isn’t the best philosophical approach to support. More on this topic is likely to follow. (Thanks to Integrative Healthcare Policy Consortium chair Len Wisneski, MD for the heads-up on these rules.)